The clinical relevance of oral contraceptive pill-induced plasma lipid changes: facts and fiction

Article Abstract:

Altered lipid metabolism is associated with cardiovascular disease. High-density lipoproteins (HDL) are considered beneficial because they transport cholesterol away from blood vessels to protect against the build-up of atherosclerotic plaques. Low-density lipoproteins (LDL), on the other hand, do the opposite, and in high quantities are considered harmful. Much has been written linking cardiovascular disease with oral contraceptive use. Oral contraceptives are said to produce changes in lipid metabolism that promote atherosclerosis. However, when these accusations are examined closer, there is no evidence supporting this claim. Most of the associated fatal cardiovascular events were heart attacks and brain hemorrhages. Furthermore, most of the deaths were in pill-takers over the age of 40 who also smoked cigarettes. These sudden events are more likely to be caused by abnormalities in the blood clotting process, in which blood clots form (thrombosis) and block blood vessels supplying the heart or brain. An examination of all available literature concerning the atherosclerotic-associated risk of oral contraceptives reveals that oral contraceptives do not produce atherosclerosis. Furthermore, studies have shown that the duration of oral contraceptive use does not affect cardiovascular risk status, which would be expected if an atherosclerotic mechanism was at work. Several conclusions can be reached: cardiovascular risk applies only to women currently using the pill and not past users; those progestogens that have the greatest antiestrogen effect are the most useful in minimizing strong effects of estrogen; a lipid profile that is beneficial may have an adverse effect upon the clotting process; and a well-balanced low-dose oral contraceptive pill, with no one hormone predominating, is the best protection against increased risk of cardiovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lipid metabolism, Atherosclerosis

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Clinical aspects of the relationship between oral contraceptives and abnormalities of the hemostatic system: relation to the development of cardiovascular disease

Article Abstract:

There is an association between oral contraceptive use and cardiovascular disease. It is thought that the hormones contained in the oral contraceptive formulas create an environment which affects the clotting cascade by altering clotting factors. Blood clots form, dislodge, and block arteries and veins of the heart or the brain, interrupting the blood supply and causing a heart attack or stroke. The effect of estrogen on clotting factors is discussed. Estrogen affects events in the arteries and veins, while progestogens affect events that take place in the arteries only. In men, the levels of clotting factors, such as factor VIIc and fibrinogen, and cholesterol in the blood have been related to the risk of cardiovascular events. In a study performed on women, oral contraceptive users had more fibrinogen, factor VIIc and factor XII (Hageman factor) than nonusers. Furthermore, the more estrogen contained in the oral contraceptive formula, the more the clotting factors are increased. Since there is a correlation between clotting factors and cardiovascular events in men, it is highly likely that the same mechanism is at work in women taking oral contraceptives. Women who are taking oral contraceptives are at risk for cardiovascular events through changes in the clotting process, leading to thrombosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Cardiovascular system, Circulatory system, Blood coagulation factors

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Effects on hemostatic variables of desogestrel- and gestodene-containing oral contraceptives in comparison with levonorgestrel-containing oral contraceptives: a review

Article Abstract:

Third-generation oral contraceptives do not appear to affect parts of the blood clotting system. Studies published in 1995 reported an increased risk of abnormal blood clotting in users of third-generation oral contraceptives but other studies found no such risk. A review of 18 studies of oral contraceptives found factor VII and protein C were the only components of the blood clotting system that were affected by contraceptives containing desogestrel or gestodene. It is not clear if the effect is big enough to increase the risk of stroke or other disorders of blood clotting.

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